Post Traumatic Stress Discussion

Defined in the DSM-IV-TR as:

“the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threats to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate…”

Post Traumatic Stress Disorder (PTSD) is estimated to have a lifetime prevalence of 6.8% in Adult Americans (Kessler et al. 2010) with 4.8% of serving US and UK military personnel showing strong symptoms of the disorder (Iversen et al. 2009) with around 24% of US war veterans (Blake et al, 1990) and an estimated 22% of British Falkland Veterans (O’Brien and Hughes, 1991). Though figures are difficult to accurately predict due to the crossing symptoms of PTSD and other disorders such as depression and acute stress disorder, it’s not hard to understand why PTSD is a concern for military forces, its usually caused by an experience with death or violence, which they frequently and its prevalence in veterans of conflict it remarkably higher than prevalence in the average population.

The usual thought of PTSD when it comes to symptoms is the re-experiencing of the event by the affected individual, usually an experience of the sensory impressions and emotions during the event, though lacking in a time frame (Ehlers, Hackmann & Michael, 2010) which results in the individual to lose focus on the present, as their memory of past stimuli and emotion is overwriting current stimuli and emotion. Though it has also been argued Trauma need not be present for one to develop the symptoms of PTSD (Scott & Stradling, 2011), however the research stated in these cases it should not be classed as PTSD due to conflict with the description of cause.

This is not the only symptom however as the memories should motivate a change in emotion or action, usually efforts of avoidance toward the subject of the experience, it is a fear of the experience, not anxiety (Lang, Davis & Öhman, 2000). While avoiding a bad memory might sound like a common thing to do, it begs a question, everyone has memories they’d rather not have, so why in PTSD does this motivate avoidance behaviours when usually we tend to ignore our negative memories? Well the cognitive model of PTSD by Ehlers & Clark (2000) attempts to explain this:

Figure 1: Cognitive Model of PTSD (Ehlers & Clark, 2000)
Figure 1: Cognitive Model of PTSD (Ehlers & Clark, 2000) 

As can be seen in the model the avoidant behaviours are not motivated by a want to numb oneself, but rather motivated by a want to gain control over the memory. PTSD is uncontrollable and unpredictable for the individual, as apposed to phobias where you know what will trigger the behaviour and simply avoid that (Foa, Steketee & Rothbaum, 1989); it is human nature to desire control and we are willing to suppress our emotions to do it (Norgaard, 2006). Given the choice between numbed emotion and intense negative emotion, individuals with PTSD are motivated to numb their emotions as there is less negativity in their experiences as a result.

It is also the fear which increases arousal in PTSD, not just while awake but during sleep as well (Woodward, Murburg & Bliwise, 2000).  While it may sound contrasting that PTSD both numbs us and causes increased arousal, it is for similar reasons that they happen, it is fear that triggers our fight or flight response (Selye, 1956). This explains that while avoidance behaviours are motivated by the fear and negative emotion of PTSD, the arousal is actually a forced response from the body due to evolution, there is no motivation to be hyper-vigilant, there is simply no choice.

The DSM-IV-TR finishes by explaining that symptoms should be persistent and last for longer than one month, but hopefully here I have helped explain what causes the intense emotion in PTSD and why those with it feel motivated to develop avoidant, numbing strategies; while their body is forcing them into a state of greater arousal.

Until the next blog that is all from me, hope you’ve not been bored by my writing and maybe understand a little better about why PTSD is so different to average fears and bad memories.

 

– – – – – Bibliography – – – – –

American Psychiatric Association (Ed.). (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR®. American Psychiatric Pub.

Blake, D.D., Keane, T. M., Wine, P. R., Mora, C., Taylor, K. L., & Lyons, J. A. (1990). Prevalence of PTSD symptoms in combat veterans seeking medical treatment. Journal of Traumatic Stress3(1), 15-27.

Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour research and therapy38(4), 319-345.

Ehlers, A., Hackmann, A., & Michael, T. (2004). Intrusive re‐experiencing in post‐traumatic stress disorder: Phenomenology, theory, and therapy. Memory,12(4), 403-415.

Foa, E. B., Steketee, G., & Rothbaum, B. O. (1989). Behavioral/cognitive conceptualizations of post-traumatic stress disorder. Behavior therapy20(2), 155-176.

Iversen, A. C., van Staden, L., Hughes, J. H., Browne, T., Hull, L., Hall, J., … & Fear, N. T. (2009). The prevalence of common mental disorders and PTSD in the UK military: using data from a clinical interview-based study. BMC psychiatry9(1), 68.

Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry62(6), 617.

Lang, P. J., Davis, M., & Öhman, A. (2000). Fear and anxiety: animal models and human cognitive psychophysiology. Journal of affective disorders61(3), 137-159.

Norgaard, K. M. (2006). “People Want to Protect Themselves a Little Bit”: Emotions, Denial, and Social Movement Nonparticipation*. Sociological Inquiry,76(3), 372-396.

O’Brien, L. S., & Hughes, S. J. (1991). Symptoms of post-traumatic stress disorder in Falklands veterans five years after the conflict. The British Journal of Psychiatry159(1), 135-141.

Scott, M. J., & Stradling, S. G. (1994). Post‐traumatic stress disorder without the trauma. British Journal of Clinical Psychology33(1), 71-74.

Selye, H. (1956). The stress of life.

Woodward, S. H., Murburg, M. M., & Bliwise, D. L. (2000). PTSD-related hyperarousal assessed during sleep. Physiology & behavior70(1), 197-203.

1 thought on “Post Traumatic Stress Discussion

  1. PTSD could be seen as an extreme conditioned response. When a person spends a long time in an extremely dangerous and terrifying environment they could become conditioned to be consistently scared or alert, this becomes maladaptive when they return to their normal lives. Jubran et al (2010) showed that patients with PTSD were more likely to recover if they were slowly brought out of the warzone, this shows that patients could be slowly desensitised to function in their normal lives, this method did not work for everyone, which suggests that some people may have suffered a different kind of psychological damage. There are also huge individual differences in whether or not a soldier will develop PTSD, Frueh (2010) showed that only 3-6% of solider returning from the Iraq war suffered from PTSD, many soldiers suffered as badly as these 3-6% and did not develop PTSD. This suggests that something about the individual soldier mediates whether they will develop PTSD , perhaps an intervention should be designed which could train soldiers not to develop the disorder before they enter the warzone. Although of course the best method to prevent PTSD would be to stop going to war with people.

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